中老年脑外伤患者急性创伤性凝血病的危险因素分析  

Clinical analysis of risk factors for acute traumatic coagulopathy in middle-aged and elderly patients with traumatic brain injury

作　　者：程亚娟 陆士奇[2] 徐进步[1] 王小娟 李松 Cheng Ya-juan;Lu Shi-qi;Xu Jin-bu;Wang Xiao-juan;Li Song(Department of Critical Medicine,the Second People's Hospital of Lianyungang,Lianyungang 222000,China)

机构地区：[1]连云港市第二人民医院重症医学科,江苏连云港222000 [2]苏州大学附属第一医院急诊科,江苏苏州215006 [3]连云港市急救中心,江苏连云港222000

出　　处：《中国急救医学》2020年第2期117-122,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的确定急性单纯性创伤性脑损伤(iTBI)是否是急性创伤性凝血病(acutetraumatic coagulation,ATC)的独立危险因素,以及评估与该并发症相关的危险因素.方法回顾性收集了2013年6月1日至2018年6月1日期间苏州大学附属第一医院符合研究标准的急性创伤患者345例.根据简明损伤评分量表(AIS评分)将纳入研究的患者分为三组:急性单纯性创伤性脑损伤组(iTBI组)、含TBI的多发伤组及非TBI的多发伤组.以ATC及进展性出血性损伤(progressive hemorrhagic injury,PHI)作为因变量,分别建立多因素Logistic回归模型,分析ATC、PHI的危险因素.结果本研究纳入了345例符合标准的患者作为研究对象,其中iTBI组78例;含TBI的多发伤组(TBI+组)120例;非TBI的多发伤组(NTBI组)147例.TBI+组患者ATC的发生率最高(36.7%),与类似损伤程度的NTBI患者比较,iTBI相关ATC的发生率并无明显升高.ATC患者的总体院内病死率为39.3%,而非ATC患者的总病死率为17.6%(P<0.01).iTBI不是发生凝血功能障碍的独立危险因素(OR 1.25,95%CI0.34~4.67,P=0.73).多变量分析确定了创伤严重程度评分(ISS)、格拉斯哥昏迷评分(GCS)≤8分、休克指数>1及年龄>75岁是创伤后凝血功能障碍的独立危险因素.多变量分析确定了ISS评分、INR>1.5及血小板计数(PLT)<100×109/L均与PHI独立相关.结论①iTBI不是发生凝血功能障碍的独立危险因素,但当其合并多发伤时则明显增加ATC的发生率.②ISS评分、GCS评分≤8分、休克指数>1及年龄>75岁是创伤后发生ATC的独立危险因素.③ISS评分INR>1.5及PLT<100×109/L均是PHI的独立危险因素.Objective To determine whether acute isolated traumatic brain injury(iTBI)is an independent risk factor for acute traumatic coagulopathy(ATC)and to assess the outcomes and risk factors associated with this complication.Methods A retrospective collection of 345 patients who met the study criteria during the period from June 1,2013 to June 1,2018 in the First Affiliated Hospital of Soochow University.Patients were divided into 3 groups according to the abbreviated injury scale(AIS score):isolated traumatic brain injury group(iTBI group);TBI combined with multiple trauma group(TBI+group);severe multi-system trauma with non-TBI group(NTBI group).Different factors such as ATC and progressive hemorrhagic injury(PHI)were used to establish different multivariate Logistic regression models to analyze the risk factors of ATC and PHI.Result A total of 345 eligible patients were included in the study,including 78 patients of iTBI group,120 patients of TBI+group,and 147 cases of NTBI group.Patients in the TBI+group had the highest incidence of ATC(36.7%),and there was no significant increase in the incidence of iTBI-related ATC compared with NTBI patients with similar degrees of injury.The overall in-hospital mortality rate was 39.3%for the patients with coagulopathy and 17.6%for non-coagulopathy patients(P<0.01).iTBI was not an independent risk factor for coagulopathy(OR 1.25,95%Cl 0.34-4.67,P=0.73).Multivariate analysis identified injury severity score(ISS),Glasgow coma scale(GCS)≤8,shock index>1,and age>75 years were independent risk factors for coagulopathy after iTBI.Multivariate analysis determined that ISS,PLT<100 x 10^9/L and INR>1.5 were independently associated with PHI.Conclusion①iTBI is not an independent risk factor for coagulopathy,but the incidence of ATC is significantly increased in the patients with iTBI combined with multiple trauma.②ISS,GCS≤8,shock index>1,age>75 years are independent risk factors for ATC after trauma.③ISS,INR>1.5 and PLT<100 x 10^9/L are independent risk factors for PHI.

关 键 词：单纯性创伤性脑损伤(iTBI) 急性创伤性凝血病(ATC) 进展性出血性损伤(PHI) 简明损伤评分(AIS) 创伤严重程度评分(ISS) 

分 类 号：R651.15[医药卫生—外科学]